CMS Reports OPPS Hospital Claim Issues
If your accounts receivables are higher than expected in first quarter 2017, remember the old adage: If it’s too good to be true, it probably is.
Due to errors in the Medicare Claims Processing System, some Outpatient Prospective Payment System (OPPS) hospital claims with dates of service on or after January 1, 2017, may have been overpaid. Claims with the following CPT® codes may be affected: 0253T, 0335T, 24361, 25420, 25444, 25445, 27442, 27871, 28715, 28730, 37229, 43266, 45389, 62360, 64580, 69717, and 75898.
In addition, eight Comprehensive Ambulatory Payment Classification (APC) Complexity Adjustment pairs were incorrectly omitted from the claims processing system:
Primary Code Code 2 Complexity-Adjusted APC
28300 27698 5115
28300 28306 5115
33208 C9600 5224
36902 36908 5193
36903 36908 5194
36904 36908 5193
36905 36908 5194
49653 49650 5362
A correction for these issues will be implemented on April 3, reports the Centers for Medicare & Medicaid Services (CMS) in the January 19, 2017, MLN Connects. Medicare administrative contractors will automatically reprocess impacted claims; providers do not need to take any action.
NCCI Edits for Institutional and Physician Claims
National Correct Coding Initiative (NCCI) edit updates for institutional claims have regularly been implemented one quarter behind the physician claim NCCI edits due to systems issues. As a result, some physician single-quarter-only edits were not implemented for institutional claims. Starting April 3, CMS will apply the same physician NCCI edits to institutional claims, including the single-quarter-only edits.
Source: MLN Connects, January 19, 2017
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